Medicine Man Pharmacy-Brazoria LLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

30626 Issued in TX

Legal business name

MEDICINE MAN PHARMACY-BRAZORIA LLC

Practice address

102 E San Bernard St
A
Brazoria, TX 77422-5647

Phone

(979) 798-4800

Fax

(979) 798-4803

NPI assigned

Feb 11, 2016

Last updated

May 23, 2016By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Bruce W Rogers, R.PH.

Title

Owner

Phone

(979) 798-4800

Specialties & licenses 1

Addresses

Other identifiers 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Jennifer Mullis

  • Pharmacist
  • Brazoria, TX
  • NPI 1598386195
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1455148800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1463961600000",
    "number": "1679932297",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3670",
            "city": "VICTORIA",
            "state": "TX",
            "postal_code": "779033670",
            "telephone_number": "979-798-4800",
            "fax_number": "979-798-4803"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "102 E SAN BERNARD ST",
            "address_2": "A",
            "city": "BRAZORIA",
            "state": "TX",
            "postal_code": "774225647",
            "telephone_number": "979-798-4800",
            "fax_number": "979-798-4803"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEDICINE MAN PHARMACY-BRAZORIA LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-02-11",
        "last_updated": "2016-05-23",
        "status": "A",
        "authorized_official_last_name": "ROGERS",
        "authorized_official_first_name": "BRUCE",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "979-798-4800",
        "authorized_official_credential": "R.PH."
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "TX",
            "license": "30626",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TEXAS STATE BOARD OF PHARMACY",
            "identifier": "30626",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Linda Janet Pearson, PT
• Gabriela Polanco

• Community/Retail Pharmacy in Brazoria, TX
• Providers in Brazoria, TX by specialty
• Community/Retail Pharmacy in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 23, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.